Provider Demographics
NPI:1649685942
Name:GOODWIN, DEBORAH (LAC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SILVERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9708
Mailing Address - Country:US
Mailing Address - Phone:919-803-4772
Mailing Address - Fax:919-803-4772
Practice Address - Street 1:301 KEISLER DR
Practice Address - Street 2:SUITE D
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7018
Practice Address - Country:US
Practice Address - Phone:919-803-4772
Practice Address - Fax:919-803-4772
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist